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Agha-Hosseini F, Gholamrezayi E, Moosavi MS. Patch test of dental materials in Oral Lichen Planus with considering the role of saliva. Sci Rep 2021; 11:8264. [PMID: 33859299 PMCID: PMC8050088 DOI: 10.1038/s41598-021-87778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/05/2021] [Indexed: 12/04/2022] Open
Abstract
Lichen planus is the most common skin disease that affects the oral mucosa. Oral Lichen Planus is a T-cell-mediated autoimmune disorder. In the current study, for the first time, an oral cavity condition in skin patch tests with adding saliva is simulated. In addition, the patch results are compared with healthy subjects. Forty-one OLP patients and 63 healthy subjects were enrolled in the study. All participants were provided with patch tests, including allergens, in combination with saliva in chambers. Allergens from the European baseline (standard) series selected according to the most prevalent positive results in the previous study were applied. Positive results of Mercury and Cobalt tests were significantly higher in the case group. In this study, the differentiation of patients with lichen planus and lichenoid was identified according to the Van der Meij & Van der Waal criteria. The patch test was conducted for healthy individuals as well. The most important of all was the use of patients' saliva in the patch test, done for the first time in this field. In the case of OLP, a patch test can help identify positive reactions to dental materials; thus, the replacement of dental restorations may be needed.
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Affiliation(s)
- Farzaneh Agha-Hosseini
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.,The Academy of Medical Sciences, Tehran, Iran
| | - Elahe Gholamrezayi
- Department of Orthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdieh-Sadat Moosavi
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran. .,Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran.
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2
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Loman L, Uter W, Armario‐Hita JC, Ayala F, Balato A, Ballmer‐Weber BK, Bauer A, Bircher AJ, Buhl T, Czarnecka‐Operacz M, Dickel H, Fuchs T, Giménez Arnau A, John SM, Kränke B, Kręcisz B, Mahler V, Rustemeyer T, Sadowska‐Przytocka A, Sánchez‐Pérez J, Scherer Hofmeier K, Schliemann S, Simon D, Spiewak R, Spring P, Valiukevičienė S, Wagner N, Weisshaar E, Pesonen M, Schuttelaar MLA. European Surveillance System on Contact Allergies (ESSCA): Characteristics of patients patch tested and diagnosed with irritant contact dermatitis. Contact Dermatitis 2021; 85:186-197. [PMID: 33729576 PMCID: PMC8360089 DOI: 10.1111/cod.13833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Irritant contact dermatitis (ICD) is caused by the acute locally toxic effect of a strong irritant, or the cumulative exposure to various weaker physical and/or chemical irritants. OBJECTIVES To describe the characteristics of patients with ICD in the population patch tested in the European Surveillance System on Contact Allergies (ESSCA; www.essca-dc.org) database. METHODS Data collected by the ESSCA in consecutively patch-tested patients from January 2009 to December 2018 were analyzed. RESULTS Of the 68 072 patients, 8702 were diagnosed with ICD (without concomitant allergic contact dermatitis [ACD]). Hand and face were the most reported anatomical sites, and 45.7% of the ICD was occupational ICD (OICD). The highest proportions of OICD were found in metal turners, bakers, pastry cooks, and confectionery makers. Among patients diagnosed with ICD, 45% were found sensitized with no relevance for the current disease. CONCLUSIONS The hands were mainly involved in OICD also in the subgroup of patients with contact dermatitis, in whom relevant contact sensitization had been ruled out, emphasizing the need for limiting irritant exposures. However, in difficult-to-treat contact dermatitis, unrecognized contact allergy, or unrecognized clinical relevance of identified allergies owing to incomplete or wrong product ingredient information must always be considered.
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Affiliation(s)
- Laura Loman
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and EpidemiologyFriedrich‐Alexander‐University Erlangen/NürnbergErlangenGermany
| | - José C. Armario‐Hita
- Department of DermatologyUniversity Hospital of Puerto Real, University of CádizCádizSpain
| | - Fabio Ayala
- Department of DermatologyUniversity of Naples Federico IINaplesItaly
| | - Anna Balato
- Department of Advanced Biomedical SciencesUniversity of Naples Federico IINaplesItaly
| | - Barbara K. Ballmer‐Weber
- Department of DermatologyUniversity Hospital ZürichZürichSwitzerland
- Department of DermatologyUniversity Hospital Zürich and Clinic of Dermatology and Allergology, Kantonsspital St GallenZürichSwitzerland
| | - Andrea Bauer
- Department of DermatologyUniversity Hospital Carl Gustav Carus, Technical University of DresdenDresdenGermany
| | - Andreas J. Bircher
- Department of DermatologyAllergy Unit, University Hospital BaselBaselSwitzerland
| | - Timo Buhl
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | | | - Heinrich Dickel
- Department of Dermatology, Venereology and AllergologyRuhr University BochumBochumGermany
| | - Thomas Fuchs
- Department of Dermatology, Venereology and AllergologyUniversity Medical Center GöttingenGöttingenGermany
| | - Ana Giménez Arnau
- Department of DermatologyHospital del Mar, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Swen M. John
- Department of Dermatology and Environmental MedicineInstitute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm), University of Osnabrück, Lower Saxony Institute for Occupational Dermatology (NIB)OsnabrückGermany
| | - Birger Kränke
- Department of Dermatology and VenereologyMedical University of GrazGrazAustria
| | - Beata Kręcisz
- Faculty of Medicine and Health ScienceInstitute of Medical Science, Jan Kochanowski UniversityKielcePoland
- Department of DermatologyNofer Institute of Occupational MedicineŁódźPoland
| | - Vera Mahler
- Department of DermatologyUniversity Hospital of Erlangen, University of Erlangen‐Nuremberg (FAU)ErlangenGermany
- Division of AllergologyPaul‐Ehrlich‐InstitutLangenGermany
| | - Thomas Rustemeyer
- Department of Dermatology‐Allergology and Occupational DermatologyAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | | | | | - Sibylle Schliemann
- Department of Dermatology and AllergologyUniversity Hospital JenaJenaGermany
| | - Dagmar Simon
- Department of DermatologyInselspital, Bern University Hospital, University of BernBernSwitzerland
| | - Radoslaw Spiewak
- Department of Experimental Dermatology and Cosmetology, Faculty of PharmacyJagiellonian University Medical CollegeKrakowPoland
| | - Philip Spring
- Dermatologie et vénéréologie FMH, Center Médical d'EpalingesEpalingesSwitzerland
| | - Skaidra Valiukevičienė
- Department of Skin and Venereal DiseasesLithuanian University of Health SciencesKaunasLithuania
| | - Nicola Wagner
- Department of DermatologyUniversity Hospital of Erlangen, University of Erlangen‐Nuremberg (FAU)ErlangenGermany
| | - Elke Weisshaar
- Department of Dermatology, Occupational DermatologyUniversity Hospital HeidelbergHeidelbergGermany
| | - Maria Pesonen
- Division Occupational MedicineFinnish Institute of Occupational HealthHelsinkiFinland
| | - Marie L. A. Schuttelaar
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
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3
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Genetics and Individual Predispositions in Contact Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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4
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Brans R, John SM, Frosch PJ. Clinical Aspects of Irritant Contact Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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5
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de Bakker E, van der Putten MAM, Heymans MW, Spiekstra SW, Waaijman T, Butzelaar L, Negenborn VL, Beekman VK, Akpinar EO, Rustemeyer T, Niessen FB, Gibbs S. Prognostic tools for hypertrophic scar formation based on fundamental differences in systemic immunity. Exp Dermatol 2021; 30:169-178. [PMID: 32618380 PMCID: PMC7818462 DOI: 10.1111/exd.14139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/07/2020] [Accepted: 06/22/2020] [Indexed: 11/29/2022]
Abstract
Unpredictable hypertrophic scarring (HS) occurs after approximately 35% of all surgical procedures and causes significant physical and psychological complaints. Parallel to the need to understanding the mechanisms underlying HS formation, a prognostic tool is needed. The objective was to determine whether (systemic) immunological differences exist between patients who develop HS and those who develop normotrophic scars (NS) and to assess whether those differences can be used to identify patients prone to developing HS. A prospective cohort study with NS and HS groups in which (a) cytokine release by peripheral blood mononuclear cells (PBMC) and (b) the irritation threshold (IT) after an irritant (sodium lauryl sulphate) patch test was evaluated. Univariate regression analysis of PBMC cytokine secretion showed that low MCP-1, IL-8, IL-18 and IL-23 levels have a strong correlation with HS (P < .010-0.004; AUC = 0.790-0.883). Notably, combinations of two or three cytokines (TNF-a, MCP-1 and IL-23; AUC: 0.942, Nagelkerke R2 : 0.727) showed an improved AUC indicating a better correlation with HS than single cytokine analysis. These combination models produce good prognostic results over a broad probability range (sensitivity: 93.8%, specificity 86.7%, accuracy 90,25% between probability 0.3 and 0.7). Furthermore, the HS group had a lower IT than the NS group and an accuracy of 68%. In conclusion, very fundamental immunological differences exist between individuals who develop HS and those who do not, whereas the cytokine assay forms the basis of a predictive prognostic test for HS formation, the less invasive, easily performed irritant skin patch test is more accessible for daily practice.
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Affiliation(s)
- Erik de Bakker
- Department of Plastic, Reconstructive and Hand SurgeryAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
- Department of Molecular Cell Biology and ImmunologAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Mirthe A. M. van der Putten
- Department of Plastic, Reconstructive and Hand SurgeryAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
- Department of Plastic surgeryOLVG HospitalAmsterdamThe Netherlands
| | - Martijn W. Heymans
- Department of Epidemiology and BiostatisticsAmsterdam UMCThe Netherlands
| | - Sander W. Spiekstra
- Department of Molecular Cell Biology and ImmunologAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Taco Waaijman
- Department of Molecular Cell Biology and ImmunologAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Liselotte Butzelaar
- Department of Plastic, Reconstructive and Hand SurgeryAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Vera L. Negenborn
- Department of Plastic, Reconstructive and Hand SurgeryAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Vivian K. Beekman
- Department of Plastic, Reconstructive and Hand SurgeryAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Erman O. Akpinar
- Department of Plastic, Reconstructive and Hand SurgeryAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Thomas Rustemeyer
- Department of DermatologyAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Frank B. Niessen
- Department of Plastic, Reconstructive and Hand SurgeryAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
| | - Susan Gibbs
- Department of Molecular Cell Biology and ImmunologAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
- Department of Oral Cell BiologyAcademic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit AmsterdamAmsterdam Movement SciencesAmsterdamThe Netherlands
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Seasonal Variation in Patch Test Results with European Baseline Series. Dermatol Res Pract 2020; 2020:8316753. [PMID: 33273912 PMCID: PMC7683155 DOI: 10.1155/2020/8316753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/30/2020] [Accepted: 11/04/2020] [Indexed: 11/26/2022] Open
Abstract
Aim To study the influence of season on patch tests results. Methods We conducted a retrospective epidemiological study which concerned all the patients of the Tunisian center, who consulted in the Dermato-Allergology Unit of Occupational Medicine Department of Farhat Hached University Hospital-Sousse (Tunisia) over a period of 07 years. All the patients were tested by the European Standard Battery allergens (BSE). Results The data of 1000 patch tests were analyzed during the study period. More than half of the patch tests (58.6%) was positive. In winter, 63% of patch tests showed a positive reaction versus 52% of patch tests in summer without a statistically significant association. However, results of lanolin alcohols, epoxy resin, and Sesquiterpene lactone mix varied significantly with season. Atopy was significantly associated with 18.8% of positive reactions in winter and only with 5.2% of positive reactions in summer (p = 0.015). Conclusion Seasonal variations in patch tests results were more significant with some allergens of European Standard Battery and in atopic patients.
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft-Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3 Guidelines: Epicutaneous patch testing with contact allergens and drugs - Short version, Part 2. J Dtsch Dermatol Ges 2020; 17:1187-1207. [PMID: 31765083 DOI: 10.1111/ddg.13971] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens.
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Affiliation(s)
- Vera Mahler
- Department of Dermatology, University Medical Center, Friedrich Alexander University, Erlangen, Germany.,Paul Ehrlich Institute, Langen, Germany
| | - Alexander Nast
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology und Allergology, Division of Evidence-based Medicine (dEBM), Berlin, Germany
| | - Andrea Bauer
- Department of Dermatology, University Medical Center, Dresden Technical University, Dresden, Germany
| | - Detlef Becker
- Department of Dermatology, University Medical Center, Mainz, Germany
| | - Jochen Brasch
- Department of Dermatology, Venereology und Allergology, University Medical Center, Kiel, Germany
| | - Kristine Breuer
- Dermatology Practice (Dermatologie Reinbek), Reinbek, Germany
| | - Heinrich Dickel
- Department of Dermatology, Venereology und Allergology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Hans Drexler
- Institute for Occupational, Social and Environmental Medicine, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Elsner
- Department of Dermatology, University Hospital Jena, Jena, Germany
| | - Johannes Geier
- Information Network of Dermatology Departments in Germany (IVDK), Göttingen University Medical Center, Göttingen, Germany
| | - Swen Malte John
- Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm), University of Osnabrück, Osnabrück, Germany
| | - Burkhard Kreft
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | | | - Hans Merk
- Professor of Dermatology and Allergology, Former Chairman of the Department of Dermatology, RWTH University, Aachen, Germany
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital Auf der Bult, Hannover, Germany
| | - Silvia Pleschka
- German Allergy and Asthma Foundation (Deutscher Allergie- und Asthmabund e.V.), Mönchengladbach, Germany
| | - Maria Portisch
- Department of Dermatology, University Medical Center, Friedrich Alexander University, Erlangen, Germany
| | | | - Elke Weisshaar
- Division of Occupational Dermatology, Department of Dermatology, University Medical Center, Heidelberg, Germany
| | - Thomas Werfel
- Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany
| | - Margitta Worm
- Department of Dermatology, Venereology und Allergology, Charité - University Medicine, Berlin, Germany
| | - Axel Schnuch
- Information Network of Dermatology Departments in Germany (IVDK), Göttingen University Medical Center, Göttingen, Germany
| | - Wolfgang Uter
- Institute for Medical Informatics, Biometrics and Epidemiology (IMBE), Medical Faculty, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
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Genetics and Individual Predispositions in Contact Dermatitis. Contact Dermatitis 2020. [DOI: 10.1007/978-3-319-72451-5_2-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Mahler V, Nast A, Bauer A, Becker D, Brasch J, Breuer K, Dickel H, Drexler H, Elsner P, Geier J, John SM, Kreft B, Köllner A, Merk H, Ott H, Pleschka S, Portisch M, Spornraft‐Ragaller P, Weisshaar E, Werfel T, Worm M, Schnuch A, Uter W. S3‐Leitlinie: Durchführung des Epikutantests mit Kontaktallergenen und Arzneimitteln – Kurzfassung Teil 2. J Dtsch Dermatol Ges 2019; 17:1187-1207. [DOI: 10.1111/ddg.13971_g] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Vera Mahler
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
- Paul‐Ehrlich‐Institut Langen
| | - Alexander Nast
- Division of Evidence‐based Medicine (dEBM)Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin Berlin
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie Universitätsklinikum Carl Gustav CarusTechnische Universität Dresden Dresden
| | | | - Jochen Brasch
- Klinik für DermatologieVenerologie und AllergologieUniversitätsklinikum Schleswig‐Holstein Kiel
| | | | - Heinrich Dickel
- Klinik für DermatologieVenerologie und AllergologieSt. Josef‐Hospital, Ruhr‐Universität Bochum Bochum
| | - Hans Drexler
- Institut für Arbeits‐Sozial‐ und Umweltmedizin der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | - Peter Elsner
- Klinik für HautkrankheitenUniversitätsklinikum Jena Jena
| | - Johannes Geier
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Swen Malte John
- Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück Osnabrück
| | - Burkhard Kreft
- Klinik und Poliklinik für Dermatologie und VenerologieUniversitätsklinikum (Saale) Halle
| | | | - Hans Merk
- Univ.‐Professor für Dermatologie & AllergologieDirektor (em.) der Hautklinik – RWTH Aachen University Aachen
| | - Hagen Ott
- Hannoversche Kinderheilanstalt (HKA): Kinder‐ und Jugendkrankenhaus auf der Bult Hannover
| | | | - Maria Portisch
- Hautklinik Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
| | | | - Elke Weisshaar
- BerufsdermatologieHautklinikUniversitätsklinikum Heidelberg Heidelberg
| | - Thomas Werfel
- Klinik für DermatologieAllergologie und VenerologieMedizinische Hochschule Hannover Hannover
| | - Margitta Worm
- Klinik für DermatologieVenerologie und Allergologie Charité – Universitätsmedizin Berlin Berlin
| | - Axel Schnuch
- Informationsverbund Dermatologischer Kliniken (IVDK) e.V. an der Universitätsmedizin Göttingen Göttingen
| | - Wolfgang Uter
- Institut für MedizininformatikBiometrie und Epidemiologie (IMBE)Medizinische Fakultät der Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen
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van de Sandt J, Roguet R, Cohen C, Esdaile D, Ponec M, Corsini E, Barker C, Fusenig N, Liebsch M, Benford D, de Brugerolle de Fraissinette A, Fartasch M. The Use of Human Keratinocytes and Human Skin Models for Predicting Skin Irritation. Altern Lab Anim 2019; 27:723-43. [DOI: 10.1177/026119299902700504] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Johannes van de Sandt
- Toxicology Division, TNO Nutrition and Food Research Institute, Utrechtseweg 48, 3704 HE Zeist, The Netherlands
| | - Roland Roguet
- Life Sciences Research, L'Oréal Advanced Research, Central Department of Products Safety, 1 Avenue Eugene Schueller, 93600 Aulnay-sous-Bois, France
| | - Catherine Cohen
- Life Sciences Research, L'Oréal Advanced Research, Central Department of Products Safety, 1 Avenue Eugene Schueller, 93600 Aulnay-sous-Bois, France
| | - David Esdaile
- Rhône-Poulenc, BP 153, 355 Rue Dostoievski, 06903 Sophia Antipolis Cedex, France
| | - Maria Ponec
- Department of Dermatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Emanuela Corsini
- Istituto di Scienze Farmacologiche, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy
| | - Carol Barker
- School of Biomedical Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Norbert Fusenig
- Forschungsschwerpunkt Tumorzellregulation, Abteilung Differenzierung und Carcinogenese, Deutsches Krebsforschungszentrum, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | | | - Diane Benford
- School of Biological Sciences, University of Surrey, Guildford, Surrey GU2 5XH, UK
| | | | - Manigé Fartasch
- Department of Dermatology, University of Erlangen, Hantmannstrasse 14, 91052 Erlangen, Germany
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11
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Brans R, John SM, Frosch PJ. Clinical Aspects of Irritant Contact Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_16-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Dittmar D, Ofenloch RF, Schuttelaar MLA. Persistence of contact allergy: a retrospective analysis. Contact Dermatitis 2017; 78:143-150. [DOI: 10.1111/cod.12912] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/20/2017] [Accepted: 09/24/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Daan Dittmar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB, Groningen The Netherlands
| | - Robert F. Ofenloch
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology; University Hospital Heidelberg; 69115, Heidelberg Germany
| | - Marie L. A. Schuttelaar
- Department of Dermatology; University Medical Centre Groningen, University of Groningen; 9700 RB, Groningen The Netherlands
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13
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Engebretsen K, Johansen J, Kezic S, Linneberg A, Thyssen J. The effect of environmental humidity and temperature on skin barrier function and dermatitis. J Eur Acad Dermatol Venereol 2015; 30:223-49. [DOI: 10.1111/jdv.13301] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/01/2015] [Indexed: 01/06/2023]
Affiliation(s)
- K.A. Engebretsen
- National Allergy Research Centre; Department of Dermato-Allergology; Gentofte University Hospital; University of Copenhagen; Hellerup Denmark
| | - J.D. Johansen
- National Allergy Research Centre; Department of Dermato-Allergology; Gentofte University Hospital; University of Copenhagen; Hellerup Denmark
| | - S. Kezic
- Coronel Institute of Occupational Health; Academic Medical Centre; 1105 AZ Amsterdam The Netherlands
| | - A. Linneberg
- Research Centre for Prevention and Health; Glostrup The Capital Region of Denmark Copenhagen Denmark
- Department of Clinical Experimental Research; Glostrup University Hospital; Glostrup Denmark
- Department of Clinical Medicine; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - J.P. Thyssen
- National Allergy Research Centre; Department of Dermato-Allergology; Gentofte University Hospital; University of Copenhagen; Hellerup Denmark
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Horita K, Tomita C, Yasoshima M, Matsunaga K. Optimal evaluation time point for patch testing to predict skin irritation of commercial topical drugs. J Dermatol 2015; 42:851-60. [PMID: 25982127 DOI: 10.1111/1346-8138.12920] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/26/2015] [Indexed: 11/27/2022]
Abstract
To develop patch testing (PT) that better reflects the skin irritation resulting from repeated applications, we methodically classified PT results and examined correlations between these results with results from repeated application tests. A total of 115 commercial topical drugs were used for patch testing. In two groups of 30 healthy individuals with normal back skin, 55 or 60 commercial topical drugs were applied to the back for 24 h. Skin reactions were scored for each group at 2 and 24 h after patch removal. Based on time-dependent changes in skin reaction at each evaluation time, PT results were classified into six different types. For repeated application testing, a total of 17 products with different types of PT results were selected. A total of 104 healthy individuals divided into three groups (n = 22-52 each) received application of 6-7 test materials, differing for each group, for 3 weeks on both arms. Incidences of positive symptoms induced by repeated drug application excluding transient erythema showed a greater correlation with reaction levels at 24 h after patch removal than 2 h after patch removal. Many test materials that triggered a high incidence of positive symptoms after repeated application also exhibited erythema or greater reaction up to 24 h after patch removal. PT offers a useful test system for predicting skin irritation that develops after repeated application of topical drug. Moreover, assessment at 24 h after patch removal is suggested as the optimal evaluation time point to reflect the results of repeated application tests.
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Affiliation(s)
- Kotomi Horita
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan.,Research Laboratory, Ikedamohando, Toyama, Japan
| | | | | | - Kayoko Matsunaga
- Department of Dermatology, Fujita Health University School of Medicine, Toyoake, Japan
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Tan YM, Wang XM, Yuan C, Tang YW, Luo SJ, Mao J, Kumar S, Pushker S, Du JF, Yuan ZK. Skin sensitivity and intolerance in Shanghai: cumulative influence of different meteorological parameters. Cutan Ocul Toxicol 2014; 34:132-8. [PMID: 25069001 DOI: 10.3109/15569527.2014.914036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although Sensitive skin (SS) conditions are reported to be affected by climate changes, the correlations with meteorological parameters remain mostly unclear. OBJECTIVE To investigate the changes of facial skin conditions in different seasons in Shanghai, including the speed and severity of the influences imposed by different meteorological parameters. METHODS Totally eighty-one healthy female volunteers completed the study in both spring (May) and summer (August). Evaluations of facial skin conditions included stimulating sensory test, clinical grading and biophysical measurements. Correlations between the meteorological parameters and ΔTEWL as well as clinical parameters were analyzed. RESULTS There was no significant difference between two seasons in lactic acid sting test. The stimulation sensations felt by Vitamin B3 (VB3) containing cream was significantly higher in May than that in August. In accordance, baseline visual scores for erythema and scaliness in May were also significantly higher than those scores in August. The baseline transepidermal water loss (TEWL) value was significantly higher in May than that in August. Positive correlations were detected between ΔTEWL and atmospheric pressure on the test day, adjust 3-day and 7-day mean of daily solar radiation respectively. There were negative correlations between ΔTEWL and temperature outside on the test day, adjust 3-day mean as well as adjust 7-day mean of relative humidity. CONCLUSIONS Facial skin conditions in summer are better than that in spring in Shanghai. The influences from atmospheric pressure and temperature are relatively quick in speed, while the influences from relative humidity and solar radiation are slow but cumulative.
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Affiliation(s)
- Yi M Tan
- Department of Skin & Cosmetic Research, Shanghai Skin Disease Hospital , Shanghai , P.R. China
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Winter season, frequent hand washing, and irritant patch test reactions to detergents are associated with hand dermatitis in health care workers. Dermatitis 2014; 24:170-5. [PMID: 23857011 DOI: 10.1097/der.0b013e318290c57f] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Irritant hand dermatitis (IHD) is common in health care workers. OBJECTIVE We studied endogenous irritant contact dermatitis threshold by patch testing and exogenous factors such as season and hand washing for their association with IHD in health care workers. METHODS Irritant patch testing with sodium lauryl sulfate (SLS), sodium hydroxide, and benzalkonium chloride at varying concentrations was measured in 113 health care workers. Examination for hand dermatitis occurred at 1-month intervals for a period of 6 months in the Midwestern United States. RESULTS Positive patch testing to low-concentration SLS was associated with IHD (P = 0.0310) after adjusting for age, sex, ethnicity, season, history of childhood flexural dermatitis, mean indoor relative humidity, and glove and hand sanitizer usage. Subjects with a positive patch test to SLS were 78% more likely to have occurrence of IHD (incidence rate ratio [IRR] = 1.78; 95% confidence interval [CI], 0.92-3.45). Hand washing frequency (≥10 times a day; IRR = 1.55; 95% CI, 1.01-2.39) and cold season (IRR = 2.76; 95% CI, 1.35-5.65) were associated with IHD. No association was found between history of childhood flexural dermatitis and IHD in this population. CONCLUSIONS Both genetic and environmental factors are important in the etiology of IHD and should be considered in designing strategies to protect, educate, and treat susceptible individuals.
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Horita K, Tanoue C, Yasoshima M, Ohtani T, Matsunaga K. Study of the usefulness of patch testing and use test to predict the safety of commercial topical drugs. J Dermatol 2014; 41:505-13. [DOI: 10.1111/1346-8138.12505] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/29/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Kotomi Horita
- Department of Dermatology; Fujita Health University School of Medicine; Toyoake Japan
- Research Laboratory; Ikedamohando; Nakaniikawa Japan
| | - Chiaki Tanoue
- Research Laboratory; Ikedamohando; Nakaniikawa Japan
| | | | - Takao Ohtani
- Department of Dermatology; Fujita Health University School of Medicine; Toyoake Japan
- Department of Dermatology; Kariya Orthopedic Hospital; Kariya Japan
| | - Kayoko Matsunaga
- Department of Dermatology; Fujita Health University School of Medicine; Toyoake Japan
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Fernandez TL, Van Lonkhuyzen DR, Dawson RA, Kimlin MG, Upton Z. Characterization of a human skin equivalent model to study the effects of ultraviolet B radiation on keratinocytes. Tissue Eng Part C Methods 2014; 20:588-98. [PMID: 24219750 DOI: 10.1089/ten.tec.2013.0293] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The incidences of skin cancers resulting from chronic ultraviolet radiation (UVR) exposure are on the incline in both Australia and globally. Hence, the cellular and molecular pathways that are associated with UVR-induced photocarcinogenesis need to be urgently elucidated, in order to develop more robust preventative and treatment strategies against skin cancers. In vitro investigations into the effects of UVR (in particular, the highly mutagenic UVB wavelength) have, to date, mainly involved the use of cell culture and animal models. However, these models possess biological disparities to native skin, which, to some extent, have limited their relevance to the in vivo situation. To address this, we characterized a three-dimensional, tissue-engineered human skin equivalent (HSE) model (consisting of primary human keratinocytes cultured on a dermal-derived scaffold) as a representation of a more physiologically relevant platform to study keratinocyte responses to UVB. Significantly, we demonstrate that this model retains several important epidermal properties of native skin. Moreover, UVB irradiation of the HSE constructs was shown to induce key markers of photodamage in the HSE keratinocytes, including the formation of cyclobutane pyrimidine dimers, the activation of apoptotic pathways, the accumulation of p53, and the secretion of inflammatory cytokines. Importantly, we also demonstrate that the UVB-exposed HSE constructs retain the capacity for epidermal repair and regeneration after photodamage. Together, our results demonstrate the potential of this skin equivalent model as a tool to study various aspects of the acute responses of human keratinocytes to UVB radiation damage.
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Affiliation(s)
- Tara L Fernandez
- 1 Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation , Queensland University of Technology, Kelvin Grove, Australia
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19
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Meteorology and ethnicity as critical factors in HRIPT: Comparing responses between Chinese and Indian ethnicities. Regul Toxicol Pharmacol 2013; 66:59-65. [DOI: 10.1016/j.yrtph.2013.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/12/2013] [Accepted: 02/14/2013] [Indexed: 11/19/2022]
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Review of skin irritation/corrosion Hazards on the basis of human data: A regulatory perspective. Interdiscip Toxicol 2012; 5:98-104. [PMID: 23118595 PMCID: PMC3485661 DOI: 10.2478/v10102-012-0017-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 05/15/2012] [Accepted: 05/16/2012] [Indexed: 11/20/2022] Open
Abstract
Regulatory classification of skin irritation has historically been based on rabbit data, however current toxicology processes are transitioning to in vitro alternatives. The in vitro assays have to provide sufficient level of sensitivity as well as specificity to be accepted as replacement methods for the existing in vivo assays. This is usually achieved by comparing the in vitro results to classifications obtained in animals. Significant drawback of this approach is that neither in vivo nor in vitro methods are calibrated against human hazard data and results obtained in these assays may not correspond to situation in human.The main objective of this review was to establish an extended database of substances classified according to their human hazard to serve for further development of alternative methods relevant to human health as well as resource for improved regulatory classification. The literature has been reviewed to assemble all the available information on the testing of substances in the human 4 h human patch test, which is the only standardized protocol in humans matching the exposure conditions of the regulatory accepted in vivo rabbit skin irritation test.A total of 81 substances tested according to the defined 4 h human patch test protocol were found and collated into a dataset together with their existing in vivo classifications published in the literature. While about 50% of the substances in the database are classified as irritating based on the rabbit skin test, on using the 4 h HPT test, less than 20% were identified as acutely irritant to human skin. Based on the presented data, it can be concluded that the rabbit skin irritation test largely over-predicts human responses for the evaluated chemicals. Correct classification of the acute skin irritation hazard will only be possible if newly developed in vitro toxicology methods will be calibrated to produce results relevant to man.
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Abstract
Contact dermatitis from irritant and allergic sources is the reason for 6% to 10% of all dermatologic visits with considerable morbidity and economic impact. Allergic contact dermatitis is a T-cell-mediated inflammatory reaction and develops in predisposed individuals as a consequence of environmental exposure to allergens. Aging is correlated with the rate and type of contact sensitization because of "immunosenescence." The number of old people is growing around the world. This contribution reviews the main findings from published epidemiologic studies on contact allergy in elderly populations. In all examined studies, patch testing was performed in patients with cutaneous manifestations possibly related to contact dermatitis; the prevalence of contact dermatitis in the elderly was from 33% to 64%. Establishing the most frequent allergens responsible for allergic contact dermatitis in the elderly is a hard task. The commonest allergens reported were nickel sulfate, fragrance mix, diamino diphenylmethane, lanolin alcohols, paraben mix, Euxyl K400, quinoline mix, and balsam of Peru. We emphasize that allergens surveillance is needed to realize an "elderly series" for having a useful adjunct to contact allergy that may help the treatment of each patient.
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24
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25
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Jírová D, Basketter D, Liebsch M, Bendová H, Kejlová K, Marriott M, Kandárová H. Comparison of human skin irritation patch test data within vitroskin irritation assays and animal data. Contact Dermatitis 2010; 62:109-16. [PMID: 20136894 DOI: 10.1111/j.1600-0536.2009.01640.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Comparison of acceptability, skin tolerance, and compliance between handwashing and alcohol-based handrub in ICUs: results of a multicentric study. Intensive Care Med 2009; 35:1216-24. [DOI: 10.1007/s00134-009-1485-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 02/19/2009] [Indexed: 10/20/2022]
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Kerr AC, Niklasson B, Dawe RS, Escoffier AM, Krasteva M, Sanderson B, Ferguson J. A double-blind, randomized assessment of the irritant potential of sunscreen chemical dilutions used in photopatch testing. Contact Dermatitis 2009; 60:203-9. [DOI: 10.1111/j.1600-0536.2009.01516.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ethnic groups and sensitive skin: two examples of special populations in dermatology. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.ddmec.2008.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Carlsen BC, Menné T, Johansen JD. 20 Years of standard patch testing in an eczema population with focus on patients with multiple contact allergies. Contact Dermatitis 2007; 57:76-83. [PMID: 17627644 DOI: 10.1111/j.1600-0536.2007.01155.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Results of standard patch tests performed with the same methodology in one centre are rarely available over a large time span. This gives the unique opportunity to study not only prevalence but also persistency of contact allergy and characterize subpopulations. The objectives were to investigate sensitivity rates and persistencies of patch test results and characterize patients with multiple contact allergies. A 20-year retrospective database-based study of 14 998 patients patch tested with the European Standard Series was performed. 34.5% were sensitized, primarily women. Sensitivity to nickel was most frequent and least frequent to mercaptobenzothiazole, N-isopropyl-N-phenyl-p-phenylenediamine and benzocaine. Yearly proportion of negative, mono/double-allergic, and multiple-allergic cases remained stable. Persistency of positive reactions was high for para-phenylenediamine, Cl(Me)isothiazolinone, and primin and poor for paraben mix. 5.1% were multiple allergic, primarily women, and 90% got diagnosed by the first test. Frequency of multiple allergies increased with age. More multiple- than mono/double-allergic patients were tested multiple times. Persistency and sensitivity rates in a Danish eczema population are provided and are useful for decisions regarding the standard series. Patients with multiple contact allergies are typically elderly women who might have long-lasting and hard-to-treat eczema. Cumulative environmental exposure seems necessary to develop multiple allergies.
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Affiliation(s)
- Berit Christina Carlsen
- National Allergy Research Centre, Department of Dermatology, Copenhagen University Hospital Gentofte, 2820 Gentofte, Denmark.
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Comparative studies on the ocular and dermal irritation potential of surfactants. Food Chem Toxicol 2007; 45:747-58. [DOI: 10.1016/j.fct.2006.10.024] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Revised: 09/19/2006] [Accepted: 10/27/2006] [Indexed: 11/17/2022]
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Peters L, Marriott M, Mukerji B, Indra P, Iyer JV, Roy A, Rowson M, Ahmed S, Cooper K, Basketter D. The effect of population diversity on skin irritation. Contact Dermatitis 2006; 55:357-63. [PMID: 17101012 DOI: 10.1111/j.1600-0536.2006.00975.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The impact of many human variables on the response to skin irritating substances has been studied to varying degrees, including the impact of age, sex, and atopic status. However, the importance of ethnic origin has been more difficult to investigate, leading to a relative paucity of compelling data, either for or against the existence of differences. A primary reason for this lack is that studies on different ethnic groups often have to be undertaken in different locations thus introducing variables, e.g. time, environmental conditions that confound interpretations. In the present work, an attempt has been made to eliminate all variables except ethnicity by conducting a study on 2 distinct populations (Punjabis and Tamils) at the same location on the same day with a single assessor of the skin reactions, using sodium lauryl sulfate as the skin irritant. The skin reactions were assessed visually, and it was demonstrated that the modality of the reactions in these 2 populations had clear differences, but that the dose-response profiles were very similar. Thus, although the irritant response was expressed differently (e.g. erythema was much less evident in the darker Tamil population), the overall outcome was that the populations reacted in an equivalent manner.
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Affiliation(s)
- Lisa Peters
- Safety and Environmental Assurance Centre, Unilever, Colworth Laboratory, Sharnbrook, Bedfordshire, MK44 1LQ, UK
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Farage M, Elsner P, Maibach H. Influence of usage practices, ethnicity and climate on the skin compatibility of sanitary pads. Arch Gynecol Obstet 2006; 275:415-27. [PMID: 17514373 DOI: 10.1007/s00404-006-0273-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Accepted: 10/09/2006] [Indexed: 10/23/2022]
Abstract
Modern disposable sanitary pads are becoming available worldwide. Regional differences in usage practices, ethnicity, and climate may influence their skin compatibility. Pad usage practices depend on culture, economics, and menstrual physiology. Daily usage is higher in Japan and but lower in Nigeria compared to North America or Western Europe. Evidence for ethnic differences in skin irritant susceptibility is not compelling. Dark skin may be less susceptible to certain irritants than fair skin; the Japanese may experience a higher degree of sensory irritation than Caucasians. Ambient conditions such as high temperature and humidity increase the skin temperature and skin surface moisture under sanitary pads by small but measurable amounts, causing no discernible skin irritation; vapor-permeable pad backings reduce these effects. Cold dry conditions, which can irritate exposed skin, may not affect vulvar skin to the same degree due to its elevated hydration and occlusion. To address the practical significance of these variables, results of prospective clinical trials of sanitary pads performed by industry and academic scientists in North America (Indiana), Mexico, Western Europe (Munich, Athens, Goteborg, Sweden), Eastern Europe (Kiev) and Africa (Abuja, Nigeria) were reviewed. Despite the diverse range of conditions, no significant adverse skin effects were observed with modern pads compared to traditional pad designs. Study participants generally preferred modern pads for performance and comfort.
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Affiliation(s)
- Miranda Farage
- The Procter & Gamble Company, Winton Hill Business Center, Feminine Care Clinical Sciences, 6110 Center Hill Rd, Box 136, Cincinnati, OH 45224, USA.
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Tornier C, Rosdy M, Maibach HI. In vitro skin irritation testing on reconstituted human epidermis: Reproducibility for 50 chemicals tested with two protocols. Toxicol In Vitro 2006; 20:401-16. [PMID: 16229985 DOI: 10.1016/j.tiv.2005.09.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2005] [Indexed: 11/21/2022]
Abstract
Since it is of high importance to establish the skin irritation potential of industrial chemicals, toxicologists developed tests on various skin models. Most test data come from the rabbit Draize test, but its reproducibility is questionable. Some human in vivo test data exist, but they concern only few compounds. The emergence of new tools such as reconstituted human skin tissues offers a promising future to alternative methods. We describe here two in vitro skin irritation test protocols performed on reconstituted human epidermis. One is a direct topical application test and the other an in vitro patch test. Both protocols were performed using multiple endpoint analysis including cell viability (MTT reduction), histology, and IL-1alpha release. Fifty chemicals were tested: 20 compounds were used in the ECVAM pre-validation study and 30 products were previously tested in a human in vivo patch test. These in vitro skin irritation tests have not only the advantages of enhanced convenience and of reduced costs, but a good reproducibility is observed by endpoint, and by compound. A prediction model is proposed to classify the chemicals as irritant or non-irritant, and the results are compared to available rabbit and human data. We do not wish to overgeneralize from these 50 compounds; but, instead suggest that this data set be extensively extended to include chemicals of varying physico-chemical properties.
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Affiliation(s)
- Carine Tornier
- SkinEthic Laboratories, 45, rue Saint Philippe, 06000 Nice, France
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Robinson MK, Kruszewski FH, Al-Atrash J, Blazka ME, Gingell R, Heitfeld FA, Mallon D, Snyder NK, Swanson JE, Casterton PL. Comparative assessment of the acute skin irritation potential of detergent formulations using a novel human 4-h patch test method. Food Chem Toxicol 2005; 43:1703-12. [PMID: 16026914 DOI: 10.1016/j.fct.2005.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 05/10/2005] [Accepted: 05/23/2005] [Indexed: 11/16/2022]
Abstract
Predictive skin irritation test methods, which do not require use of animals, are needed for the pre-market assessment of detergent formulations. The utility of a novel and ethical human acute skin irritation patch test method, originally developed for chemical skin irritation assessment, was evaluated. In this IRB-approved method, subjects were patched under occlusion for increasing periods of time up to 4h in duration. The total incidence of positive skin reactions for test products was compared to a positive control (20% aqueous sodium dodecyl sulfate [SDS]). Acutely irritating formulas were defined as those showing a significantly increased or equal incidence of positive responders compared with that of SDS. The time of exposure required for 50% of subjects to show a positive skin reaction (TR50 value) was calculated for each product and enabled test product comparisons within and between studies. Using this approach, 24 detergent formulations of various types were tested in seven individual studies. The skin irritation profiles were generally consistent within product types, which could be categorized as follows (by decreasing irritancy): mold/mildew removers (average TR50 = 0.37 h) > disinfectants/sanitizers (0.64 h) > fabric softener concentrate (1.09 h) = aluminum wash (1.20 h) > 20% SDS (1.81 h) > liquid laundry detergents (3.48 h) > liquid dish detergents (4.16 h) = liquid fabric softeners (4.56 h) = liquid hand soaps (4.58 h) = shampoos (5.40 h) = hard surface cleaners (6.34 h) > powder automatic dish detergents (>16 h) = powder laundry detergents (>16 h). In addition to formulation effects, some seasonal effects were noted; particularly greater winter-time reactivity to 20% SDS and the hard surface cleaner and liquid laundry formulations. These results demonstrate the utility of this patch test method for the comparative skin irritation assessment of these different product types.
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Affiliation(s)
- Michael K Robinson
- The Procter & Gamble Company, Miami Valley Laboratories, P.O. Box 538707, Cincinnati, OH 45253-8707, USA.
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Löffler H, Becker D, Brasch J, Geier J. Simultaneous sodium lauryl sulphate testing improves the diagnostic validity of allergic patch tests. Results from a prospective multicentre study of the German Contact Dermatitis Research Group (Deutsche Kontaktallergie-Gruppe, DKG). Br J Dermatol 2005; 152:709-19. [PMID: 15840103 DOI: 10.1111/j.1365-2133.2004.06465.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is evidence that a higher skin susceptibility may induce nonspecific erythematous or weak positive reactions to contact allergens in patch testing. OBJECTIVES To evaluate whether simultaneous application of sodium lauryl sulphate (SLS) along with diagnostic patch tests with contact allergens can provide information regarding skin irritability which may help to discriminate allergic from nonspecific irritant reactions to contact allergens. METHODS Between July 2001 and June 2003, this prospective study collected patch test data of 5971 patients from 19 centres in Germany and Austria in the Information Network of Departments of Dermatology (IVDK). In addition to contact allergens (standard series and eight known 'problematic' allergens with a low reaction index and a high positivity ratio: 1,3-diphenylguanidine, amerchol L-101, benzalkonium chloride, benzoyl peroxide, cocamidopropyl betaine, octyl gallate, phenyl mercuric acetate and propylene glycol), patches with SLS 0.5% and 0.25% aq. were applied. Reactions to the allergens and to SLS were analysed at the IVDK data centre. The association between an erythematous or positive reaction to a certain allergen and an irritant reaction to SLS was assessed with logistic regression analysis, at the same time controlling for the influence of age and sex. RESULTS Of the 29 allergens of the standard series, 23 and 21 gave a higher percentage of nonspecific erythematous reactions in patients with an irritant reaction to 0.25% and 0.5% SLS, respectively, in comparison with SLS-negative patients. All eight 'problematic' allergens gave an increased percentage of nonspecific erythematous reactions. Similarly, 22 and 21 allergens of the standard series gave a higher percentage of positive allergic reactions in patients with an irritant reaction to 0.25% and 0.5% SLS, respectively, and seven of the eight 'problematic' allergens gave a higher percentage of positive allergic reactions (exception: octyl gallate). For most allergens, the markers of skin reaction (reaction index and positivity ratio) were worse in SLS-positive patients. Differences were more pronounced when testing with SLS 0.25% than with SLS 0.5%. CONCLUSIONS Because there is a convincing association between skin irritability (evaluated by SLS test) and the degree of skin reaction to contact allergens, the SLS test may help in deciding whether a doubtful erythematous or weakly 'positive' skin reaction should be interpreted as allergic or irritant.
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Affiliation(s)
- H Löffler
- Department of Dermatology, University of Mainz, Mainz, Germany.
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Fluhr JW, Bornkessel A, Akengin A, Fuchs S, Norgauer J, Kleesz P, Grieshaber R, Elsner P. Sequential application of cold and sodium lauryl sulphate decreases irritation and barrier disruption in vivo in humans. Br J Dermatol 2005; 152:702-8. [PMID: 15840102 DOI: 10.1111/j.1365-2133.2004.06309.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Irritant contact dermatitis (ICD) is one of the most frequent types of occupational dermatitis. Different factors are involved in the development of contact dermatitis. In the food-processing industry, the combined exposure to different irritants may be involved in the development of ICD. Few data have been published regarding the irritant potential of sodium lauryl sulphate (SLS) in combination with cold. OBJECTIVES The present study was intended to analyse whether cold exposure and low skin temperature influence the development of ICD. METHODS Twenty (part I) and 12 (part II) healthy volunteers were exposed twice daily for 4 days to SLS alone, different low temperatures alone (4 degrees C six times for 90 s with an interval of 20 s or 15 degrees C for 10 min) or a combination of cold and SLS (19.6 microL SLS 1% cm(-2), part I; or 52.6 microL SLS 0.5% cm(-2), part II) using the tandem repetitive irritation test. Irritant cutaneous reactions were measured by noninvasive biophysical methods with transepidermal water loss as a parameter for permeability barrier function and skin colour reflectance together with visual scoring as parameters for inflammatory reactions. RESULTS Cold alone caused no significant skin reaction compared with untreated control. Exposure to SLS alone and SLS together with cold (independent of the applied temperature of 4 or 15 degrees C) twice daily induced a clear irritant reaction and barrier disturbance. Reactions did not differ whether SLS was applied before or after cold. Furthermore, 'tandem application' of cold and SLS diminished the barrier disruption and irritant reaction compared with SLS alone. CONCLUSIONS We conclude that the application of cold may have a protective effect on the development of ICD, at least in our short-term model.
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Affiliation(s)
- J W Fluhr
- Skin Physiology Laboratory, Department of Dermatology, Friedrich-Schiller-University Jena, Erfurter Str. 35, 07740 Jena, Germany
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John SM, Uter W. Meteorological influence on NaOH irritation varies with body site. Arch Dermatol Res 2004; 296:320-6. [PMID: 15650894 DOI: 10.1007/s00403-004-0523-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Revised: 10/06/2004] [Accepted: 10/20/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dry air and cold weather have been shown to influence skin irritability. There is conflicting evidence concerning seasonal variability of irritant patch test results and there are no data concerning the influence of season on NaOH-induced irritation. PATIENTS AND METHODS A Swift Modified Alkaline Resistance Test (SMART) was carried out simultaneously on the volar forearm (FA) and the back of the hand (BOH) of 554 consecutive individuals (277 female, median age 36 years; 277 male, median age 42 years) who had previously had an occupational skin disease. The test comprises two challenges with 0.5 M NaOH each for 10 min. The clinical outcome in each patient was related to standardized data on the local ambient temperature (T) and absolute humidity (AH) on the day of examination obtained from the German Meteorological Service. RESULTS Of the 554 patients, 212 (38.3%) showed a positive reaction on the FA, and 126 (22.7%) a positive reaction on the BOH. An atopic skin disposition significantly increased the odds for a positive clinical reaction on both the FA (OR 4.8, 95% CI 3.0-7.8) and the BOH (OR 3.1, 95% CI 1.8-5.5). In a logistic regression analysis a significant association between low T and AH, respectively, and clinical reactivity to NaOH on the BOH was found. The odds of a positive reaction were increased by 3.9 (95% CI 2.1-7.6) for an ambient T of < or =6 degrees C and by 2.9 (95% CI 1.6-5.7) for an AH of < or =8 mg l(-1). The effects of AH and T on the reactivity on the BOH were even more pronounced in atopic individuals. In contrast, there was no significant association between the test outcome on the FA and climatic parameters. Furthermore, the test outcome showed no significant association with duration of healing of hand eczema or eczema at other sites before the investigation. Moreover, there were no associations detectable between previous wet work load and NaOH reactivity on both the BOH and FA. CONCLUSIONS Unlike skin challenge with sodium lauryl sulphate, challenge with NaOH on a body area not directly exposed to environmental factors (FA) seems robust against seasonal influences. Furthermore, a NaOH test in this location (FA) may provide supporting evidence to help identify individuals with atopic skin. On the BOH, seasonal effects were demonstrated. Thus, when interpreting NaOH challenges on the BOH it would seem helpful to take ambient meteorological parameters into consideration.
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Affiliation(s)
- Swen Malte John
- Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabrueck, Sedanstr. 115, 49090 Osnabrueck, Germany.
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Basketter DA, York M, McFadden JP, Robinson MK. Determination of skin irritation potential in the human 4-h patch test. Contact Dermatitis 2004; 51:1-4. [PMID: 15291823 DOI: 10.1111/j.0105-1873.2004.00385.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recently adopted legislation in Europe has increased the focus that must be placed on the development of in vitro alternatives to the traditional toxicology tests employed to identify the human health hazards associated with chemicals. Included in these is the rabbit skin-irritation test which is used to discriminate those substances which possess significant acute skin irritation potential from those which are of more limited irritation potential. So far, the considerable efforts to replace this assay with in vitro alternatives have not been successful, which may in part be due to the relatively poor quality of the existing in vivo dataset. To help address this problem, we have elected to present our complete database of information on the skin irritation potential of some 65 substances, all of which have been tested in a standard human 4-h patch test. These provide a high quality dataset, generated in man (the goal of toxicologists' health protection-related activities). The data are presented in the context of results with a concurrent positive skin irritation control to ensure that results from individual experiments can be correlated. Consequently, in vitro or in silico alternatives which can identify the significant acute human skin irritants in this group may well represent suitable alternatives to the rabbit.
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Affiliation(s)
- David A Basketter
- Safety and Environmental Assurance Centre, Unilever Colworth Laboratory, Sharnbrook MK44 1LQ, UK.
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Abstract
It is of great importance to find ways to lower the incidence of chronic irritant contact dermatitis. In this process, it is crucial to have insight in the factors that can predict irritancy. This review offers a survey of recent findings in the field of skin irritancy testing, discussed in the context of renowned, older work. Extrinsic and intrinsic factors that may determine the outcome of irritancy testing in the human skin model are considered. In recent decades, there has been increasing interest in factors influencing the development of occupational dermatitis by means of prospective cohort studies. This promising new area of investigation is discussed separately.
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Affiliation(s)
- R A Tupker
- Department of Dermatology, Antonius Hospital, NL-3430 EM Nieuwegein, The Netherlands.
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Uter W, Hegewald J, Pfahlberg A, Pirker C, Frosch PJ, Gefeller O. The association between ambient air conditions (temperature and absolute humidity), irritant sodium lauryl sulfate patch test reactions and patch test reactivity to standard allergens. Contact Dermatitis 2003; 49:97-102. [PMID: 14641358 DOI: 10.1111/j.0105-1873.2003.00178.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To support the decision as to whether erythematous patch test reactions to allergens are irritant or allergic, sodium lauryl sulfate (SLS, 0.5% in water) has been added to the standard patch tests since July 1996 in the Dortmund Department of Dermatology. Data on 1600 patients patch tested up until June 2001, as well as standardized data on ambient temperature and humidity obtained by the German Meteorological Service, were included in a logistic regression analysis taking age, sex and atopy as potential confounders into account. The pattern of association was heterogeneous: while doubtful reactions to nickel sulfate were significantly associated with dry/cold weather conditions, but not with SLS reactivity, the opposite was observed for lanolin alcohol, benzocaine and Myroxylon pereirae resin (balsam of Peru). Doubtful reactions to other allergens, namely formaldehyde, fragrance mix or p-phenylenediamine, were associated with both factors. For several other allergens of the standard series, no distinct, significant pattern could be discerned. In conclusion, meteorological conditions and SLS reactivity independently contribute information on individual irritability at the time of patch testing, and both should be considered.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology (IMBE), University of Erlangen/Nürnberg, Erlangen, Germany.
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Wöhrl S, Hemmer W, Focke M, Götz M, Jarisch R. Patch testing in children, adults, and the elderly: influence of age and sex on sensitization patterns. Pediatr Dermatol 2003; 20:119-23. [PMID: 12657006 DOI: 10.1046/j.1525-1470.2003.20204.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patch testing was done on 2776 consecutive patients (76.5% female) with a locally revised standard series of 34 contact allergens and the results analyzed for age- and gender-specific differences. At least one positive epicutaneous test reaction occurred in 48.9% of patients. Nickel (20.9%), ethylmercuric chloride (13.2%), thimerosal (11.8%), fragrance mix (9.3%), metallic mercury (8.9%), palladium (5.8%), balsam of Peru (3.8%), copper (3.7%), cobalt (3.3%), and chromium (2.3%) were the 10 most important sensitizers. The following tested allergens with sensitization rates of more than 1% were not part of the usual standard series: ethylmercuric chloride, metallic mercury, copper, propolis (1.3%), propylene glycol (1.0%). Reactions to nickel, cobalt, and palladium, but not to chromium, were significantly more abundant in females (p < 0.002, chi-squared test). The overall sensitization rate was highest in children less than 10 years old (62%) and decreased steadily, to be lowest among patients more than 70 years old (34.9%). The rate of positive reactions to nickel and thimerosal decreased with age, while fragrance mix and metallic mercury stayed at the same level through all age groups.
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Affiliation(s)
- Stefan Wöhrl
- FAZ - Floridsdorf Allergy Center, Vienna, Austria.
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Geier J, Uter W, Pirker C, Frosch PJ. Patch testing with the irritant sodium lauryl sulfate (SLS) is useful in interpreting weak reactions to contact allergens as allergic or irritant. Contact Dermatitis 2003; 48:99-107. [PMID: 12694214 DOI: 10.1034/j.1600-0536.2003.480209.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Several contact allergens are tested at concentrations which might cause irritant reactions. In this study we investigated whether the reactivity to a standard irritant is useful in identifying subjects with hyperreactive skin yielding a higher rate of doubtful or irritant reactions. Sodium lauryl sulfate (SLS) 0.5% (aqua) was tested in addition to the standard series routinely for 5 years in the Department of Dermatology, Dortmund. For data analysis, we compared reactions at D3 to the standard series, the vehicle/emulsifier and preservative series and benzoyl peroxide to the reactions obtained with SLS. Proportions were standardized for age and sex. The association between reactivity to a certain allergen and SLS reactivity as a dichotomous outcome, controlled for age and sex as potential confounders, was assessed with logistic regression analysis. Results showed that of the 1600 tested patients, 668 (41.8%) had an irritant reaction to SLS which exceeded 2 + in only 41 patients. Seasonal variation was statistically significant, showing reduced SLS reactivity in summer vs. winter. Patients with irritant reactions to SLS showed significantly more erythematous reactions to the following 10 allergens of the standard series: fragrance mix, cobalt chloride, balsam of Peru (Myroxylon pereirae), lanolin alcohol, 4-phenylenediamine base (PPD), propolis, formaldehyde, N-isopropyl-N'-phenyl-p-phenylenediamine (IPPD), benzocaine, and 4-tert-butylphenol-formaldehyde resin. No significant differences regarding strong positive allergic reactions were observed. Concerning other allergens, significantly more erythematous reactions were observed in SLS-reactive patients to benzoyl peroxide, octyl gallate, cocamidopropyl betaine, Amerchol L-101, tert-butylhydroquinone, and triethanolamine. In the SLS-reactive group of patients, the reaction index was negative for 10 allergens of the standard series compared to only 5 in the SLS non-responder group. For the first time, this study, based on a large data pool, revealed a significant association between reactivity to the irritant SLS and erythematous reactions to certain allergens. With SLS as a marker for hyperreactive skin at hand, some of these reactions can now be classified as irritant more confidently, particularly if there is no history of exposure to the allergen.
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Affiliation(s)
- J Geier
- Information Network of Departments of Dermatology (IVDK), Georg August University, Department of Dermatology, Göttingen, Germany.
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Abstract
Racial (ethnic) differences in skin properties may explain racial disparities seen in dermatologic disorders and provide insight into appropriate differences in the management of these disorders. However, racial differences in skin have been minimally investigated by objective methods and the data are often contradictory. Objective methods studied include transepidermal water loss (TEWL), water content (WC), corneocyte variability, blood vessel reactivity, elastic recovery/extensibility, pH gradient, lipid content, surface microflora, microscopic evaluation of mast cell granules, and confocal microscopy. The majority of the evidence (six out of eight studies) indicates that TEWL is greater in Black skin compared with White skin. TEWL measurements of Asian skin are inconclusive as they have been found to be equal to Black skin and greater than Caucasian skin, equal to Caucasian skin, and less than all other ethnic groups in different studies. Racial differences in WC, as measured by resistance, capacitance, conductance and impedance, are also inconclusive as the data are contradictory. While the evidence regarding corneocyte desquamation is minimal, one clinically provocative observation is that Blacks have a 2.5 times greater spontaneous desquamation rate compared with Caucasians and Asians, possibly accounting for an increased frequency of xerosis seen clinically in Blacks. With regards to blood vessel reactivity, studies can not be compared to each other because each uses different vasoactive substances. However, each study, except for one study comparing Hispanics and Whites, and another comparing Japanese and German women, reveal some degree of racial variation in blood vessel reactivity. It has been demonstrated that the pH of Black skin is less than White skin; however, the studies that have demonstrated this have done so under different skin conditions and on different anatomic sites. Racial differences in lipid content are inconclusive. Additionally, there is insufficient and conflicting evidence to make conclusions regarding racial differences in skin biomechanics and skin microflora. Microscopic evaluation reveals that Black skin contains larger mast cell granules, and differences in stuctural properties and enzymes of mast cells compared with White skin, possibly accounting for differences in pruritus experienced by the individuals of these racial groups. There exists substantial evidence to support that Black skin has a higher TEWL, variable blood vessel reactivity, decreased skin surface pH, and larger mast cell granules compared with White skin. Although some deductions have been made about Asian and Hispanic skin, further evaluation needs to be done. Differences in WC, corneocyte desquamation, elastic recovery/extensibility, lipid content and skin microflora, although statistically significant, are inconclusive.
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45
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Modjtahedi SP, Maibach HI. Ethnicity as a possible endogenous factor in irritant contact dermatitis: comparing the irritant response among Caucasians, blacks, and Asians. Contact Dermatitis 2002; 47:272-8. [PMID: 12534531 DOI: 10.1034/j.1600-0536.2002.470504.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Irritant contact dermatitis (ICD) is a common dermatological diagnosis in which endogenous and exogenous factors have been implicated. This review explores ethnicity as a possible endogenous factor. While there is a clinical consensus that blacks are less reactive and Asians are more reactive than Caucasians, the data supporting this hypothesis rarely reaches statistical significance. The studies reviewed do not provide sufficient evidence to determine that race is a predisposing factor to the degree of irritation in ICD. We conclude that race could be a factor in ICD, which has practical consequences regarding topical product testing requirements, an ever-expanding global market, occupational risk assessment, and the clinical thinking about ICD. Pitfalls in defining differences are discussed.
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Affiliation(s)
- S P Modjtahedi
- University of California, San Francisco, California, USA
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46
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Abstract
Patch testing with chemical irritants almost always produces a striking variability in the intensity of reaction between individuals, even amongst normal, healthy subjects. Whilst there have been many attempts to define factors which predispose to heightened or, conversely, to diminished reactivity, the underlying cellular mechanisms responsible for the variability remain poorly understood. In this review, a number of possible explanations are proposed, with a particular emphasis on those which relate to the influence of pre-existing disease or to the genetic regulation of certain immunological and inflammatory processes.
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Affiliation(s)
- C M Willis
- Department of Dermatology, Amersham Hospital, Whielden Street, Amersham, UK.
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47
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Felter SP, Robinson MK, Basketter DA, Gerberick GF. A review of the scientific basis for uncertainty factors for use in quantitative risk assessment for the induction of allergic contact dermatitis. Contact Dermatitis 2002; 47:257-66. [PMID: 12534529 DOI: 10.1034/j.1600-0536.2002.470502.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Safety evaluations for chemicals which possess the ability to cause sensitization by skin contact have traditionally been done using an ad hoc comparative risk assessment technique. Recently, several papers have been published supporting the use of an alternative, and potentially better, quantitative risk assessment approach. While they represent a relatively new approach to risk assessment for sensitizers, quantitative methods have been used for decades to support risk assessments for systemic toxicity. Historically, these methods have involved the extrapolation of toxicity data - generally from studies in laboratory animals at relatively high doses to human exposures at lower doses. For toxicity endpoints with a threshold, this process has traditionally involved the use of uncertainty factors. For example, uncertainty factors are commonly used to extrapolate from laboratory animals to humans, and from 'average' humans to sensitive subpopulations. In the absence of data to support a different value, a default factor of 10 is widely accepted for each of these areas. Recent papers have advocated the use of a similar approach to characterize the risk of the induction of skin sensitization by allergens of varying potency and potential for skin contact. As with other forms of toxicity, a quantitative assessment of risk for allergic skin reactions can be approached by identifying a NOAEL (no observed adverse effect level) and applying appropriate uncertainty factors. Three major areas of data extrapolation have been identified: inter-individual susceptibility, the influence of vehicle or product matrix, and exposure considerations. This paper provides an overview of each of these areas with an evaluation of the available scientific database to support an uncertainty factor in the range of 1-10 for each area.
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Affiliation(s)
- Susan P Felter
- The Procter & Gamble Co., Miami Valley Laboratories, Cincinnati, OH, USA. felter.sp.@pg.com
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48
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Dickel H, Kuss O, Schmidt A, Kretz J, Diepgen TL. Importance of irritant contact dermatitis in occupational skin disease. Am J Clin Dermatol 2002; 3:283-9. [PMID: 12010073 DOI: 10.2165/00128071-200203040-00006] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Irritant contact dermatitis (ICD), provoked by work materials or workflows, is believed to be a frequent cause of occupational skin disease (OSD). Data of incidence rates of ICD within different occupations are inadequate. OBJECTIVE We conducted a population-based study to identify occupational groups at risk for irritant and allergic contact dermatitis (ACD). METHODS The data are based on all workers' compensation claims reported to our register of OSDs in Northern Bavaria [Berufskrankheitenregister Haut-Nordbayern (BKH-N)], Germany. RESULTS From 1990 to 1999, 5285 patients had their cases completely assessed and recorded by government-employed physicians. We calculated the incidence rates of ICD and ACD in various occupations, divided into 24 occupational groups, in co-operation with the German State Institute of Labor and Occupation; there were a known total number of employees in each of the occupations. In these groups 3097 (59%) patients with OSD were observed, with an overall annual incidence rate of 4.5 patients per 10,000 workers for ICD, compared with 4.1 patients per 10,000 workers for ACD. The highest ICD annual incidence rates were found in hairdressers (46.9 per 10,000 workers per year), bakers (23.5 per 10,000 workers per year), and pastry cooks (16.9 per 10,000 workers per year); at the same time ICD was the main diagnosis of OSD in pastry cooks (76%), cooks (69%), food processing industry workers and butchers (63%), mechanics (60%), and locksmiths and automobile mechanics (59%). The results of a questionnaire showed frequent skin contact with detergents (52%), disinfectants (24%), and acidic and alkaline chemicals (24%) in the workplace. CONCLUSION Based on the incidence data of the BKH-N, this study identified occupational groups with a high risk of ICD. Different frequencies of ICD and ACD within a single group are demonstrated. The frequent usage of detergents is being addressed because of the introduction of German legislation of recent date (the Approved Code of Practice 531 on 'wet work').
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Affiliation(s)
- Heinrich Dickel
- Department of Clinical Social Medicine, Center of Occupational and Environmental Dermatology, University Hospital of Heidelberg, Heidelberg, Germany
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49
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Robinson MK, Cohen C, de Fraissinette ADB, Ponec M, Whittle E, Fentem JH. Non-animal testing strategies for assessment of the skin corrosion and skin irritation potential of ingredients and finished products. Food Chem Toxicol 2002; 40:573-92. [PMID: 11955663 DOI: 10.1016/s0278-6915(02)00005-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The dermatotoxicologist today is faced with a dilemma. Protection of workers and consumers from skin toxicities (irritation and allergy) associated with exposure to products, and the ingredients they contain, requires toxicological skin testing prior to manufacture, transport, or marketing. Testing for skin corrosion or irritation has traditionally been conducted in animals, particularly in rabbits via the long established Draize test method. However, this procedure, among others, has been subject to criticism, both for its limited predictive capacity for human toxicity, as well as for its use of animals. In fact, legislation is pending in the European Union which would ban the sale of cosmetic products, the ingredients of which have been tested in animals. These considerations, and advancements in both in vitro skin biology and clinical testing, have helped drive an intensive effort among skin scientists to develop alternative test methods based either on in vitro test systems (e.g. using rat, pig or human skin ex vivo, or reconstructed human skin models) or ethical clinical approaches (human volunteer studies). Tools are now in place today to enable a thorough skin corrosion and irritation assessment of new ingredients and products without the need to test in animals. Herein, we describe general testing strategies and new test methods for the assessment of skin corrosion and irritation. The methods described, and utilized within industry today, provide a framework for the practicing toxicologist to support new product development initiatives through the use of reliable skin safety testing and risk assessment tools and strategies.
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Affiliation(s)
- M K Robinson
- Human & Environmental Safety Division, The Procter & Gamble Co., Miami Valley Laboratories, Cincinnati, OH, USA.
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50
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Robinson MK. Population differences in acute skin irritation responses. Race, sex, age, sensitive skin and repeat subject comparisons. Contact Dermatitis 2002; 46:86-93. [PMID: 11918601 DOI: 10.1034/j.1600-0536.2002.460205.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The variability in human skin irritation responses has been well documented and can confound our ability to accurately assess differences in skin reactivity between human subpopulations. In the current analysis, results were compiled from nine acute irritation patch test studies, conducted at three test facilities over a 5-year period. Four irritant test chemicals, 20% sodium dodecyl sulphate, 100% decanol, 100% octanoic acid and 10% acetic acid, were tested in sufficient numbers of test subjects to enable the stratification of results for different human subpopulations. An increased reactivity was noted for Asian versus Caucasian subjects for each of three test chemicals, in contrast to the previously described individual study results from which these data were drawn. Male subjects were directionally or significantly more reactive to each of the test chemicals than female subjects. The oldest age cluster of subjects (56-74 years of age) was directionally or significantly less reactive than younger age clusters. There was virtually identical reactivity between self-assessed 'sensitive' and normal skin groups. Lastly, there was little correlation between the results from individual subjects tested in two or more studies with the same chemicals. These results add to our general understanding of population differences in skin reactivity and the potential implications for ingredient and product skin safety testing and risk assessment.
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Affiliation(s)
- Michael K Robinson
- The Procter & Gamble Co., Miami Valley Laboratories, Cincinnati, OH 45253-8707, USA
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